Entries in midwifery care
(8)

I'm continuing the line of questions as they come from the MothersOwnBirth.com site. I've found some questions are important and others useless. Here we go.

"Do you keep statistics of your births and what happens at each one?"

As one wonderful LM I know said, one’s statistics do not really determine the safety of the midwife in question. Someone newer (like me) might transfer for something a more experienced midwife might feel comfortable keeping at home. Or, conversely, something an experienced midwife might transfer for, a greener midwife (not like me!) might not grasp the gravity of the situation and call for help. Therefore, a midwife’s statistics can be extremely misleading. If you are trying to see if you might be transferred for something, I would say there is zero way of knowing until after the birth. As much as any of us wishes it wasn’t so, birth can turn tragic (anywhere, not just at home) and help needed immediately. We certainly do all we can to eliminate risks, but there are simply unknowns that occur and, if I had to put a percentage on it, I would say almost all women (or babies) have the potential for needing help during or after the birth. This is why it’s so important to not go by something as variable and non-concrete as statistics.

If, however, you want to know what she has transferred for, that’s an absolutely valid question. But, what do you do with the information? This is where the knowing what answers you are looking for comes into play again. Merely knowing why the midwife transferred/transported doesn’t answer how the situation came to be in the first place. For example, if she transported for fetal distress… was mom in labor for 25+ hours? Was she vomiting? Dehydrated? Starving? Wouldn’t change positions when asked to? Was there meconium? Was the baby post-dates? Early? Was there a nuchal cord or a compound presentation found afterwards? And we could go on and on. You see there isn’t just a cut and dry answer to many/most of the questions about transfers and transports.

But, do you want to know the details? Are you prepared to sit and listen to case study after case study? Has the midwife’s sharing these details gotten approval from the mom? Is the midwife breaking her confidentiality agreement? This is an important part of her character, too.

When you ask about transfers and transports, isn’t it true you are hiring the midwife to make these judgment calls? Your real question is, are you able to trust that this midwife will make the right decision for you if the situation calls for it… during your pregnancy, during labor and the birth, as well as postpartum. If you are unsure, keep looking.

The same website above suggests you ask:

"Are you a member of your state midwives organization?"

Who cares? What does that have to do with anything? Many state organizations are a model of disarray and confusion.

We all know the Better Business Bureau, right? How they are held up as a standard of how wonderful a business is if they are on their list? Did you know that to get on their list, all you do is pay a yearly fee? That’s it. Nothing more. When I owned my holistic healthcare center, I learned that everything from the Chamber of Commerce to getting articles in local papers was nothing more than paying for the privilege. Belonging to a midwifery organization is no different. One of the main reasons to join any group is to be on their referral lists. That’s it. No prestige at all in paying for your own advertising.

"What is your hospital transfer rate (or, how many times have you had to go if it's low)?"

We already went over this one above.

"What happens if I go past 42 weeks?"

As I mentioned in Part 2, you should already know what your community’s standard of care is on this issue. There is a lot more than comes before this question.

“Do you suggest a vaginal exam when I get closer to term?”

This lets you know she has a mindset that seeing what’s going on sooner than later can help know where the course of action might be headed. While I don’t think an exam should be done at 37-38 weeks like most OBs do, there is something to be said for one at 40-ish weeks. I’ve often said you can be 4 centimeters for four weeks and still hang out there for even longer or you could be long, closed and high and deliver by sunset, but the reality is those are the rare cases. The truth is that most women show early signs of “ripening” and these are helpful in determining what the midwife might start suggesting the mom do sooner than later. Some midwives suggest these “things to do” (Evening Primrose Oil [EPO] on the cervix, homeopathics if midwife and mom believes in them, encouraging a lot of sex and nipple stimulation, etc. starting at 37, 38, 39 weeks) for every woman either because they do not do vaginal exams frequently or because, in their experience, many moms benefit from these instructions. But, other midwives are of the mindset that the body will ripen in her own good time and these extras are superfluous for most women. These types of midwives still fall into two (or more!) categories; the never-do-an-exam-until-the-last-minute variety or the do-an-exam-and-let’s-see-what’s-happening-and-decide-with-the-information-what-to-do types. You get to pick who is a better fit for you and your baby.

“Have you had any women or their families dissatisfied with their care? Please explain. How did you handle this?”

I’m not quite sure what the point of this would be except to possibly find out if the midwife gave money back to a dissatisfied client. A better question might be “If I’m dissatisfied with my care, how would we go about resolving the dispute?” The answers might be everything from taking it to Peer Review (where sister-midwives talk openly about cases and get advice from each other on what to do with complications or to process difficult births) to mediation. It is a rare… very rare… midwife who hasn’t had at least one person, for unexplained reasons, not be satisfied with her care. Each midwife handles it her own way and sometimes, the money is returned (or a portion of it), but not always. To me, as a midwife, if someone asks about disputes before care even begins, that’s a giant red flag against taking on that client, but not all midwives feel that way. And, as a pregnant woman, you certainly have the right to ask the question.

A question not often asked is, “Do you have malpractice insurance?” The assumption is there isn’t liability insurance for homebirth midwives, but I recently learned that simply is not true. From the Midwifery Education Accreditation Council site:

“Do midwives carry professional liability insurance?

“Most direct-entry midwives are not covered by professional liability insurance, unless it is required for practice in their state or for participation in healthcare plans. Some midwives cannot afford or choose not to purchase professional liability insurance, and at times it has been unavailable to purchase. Instead, most midwives rely on the personal relationships they have with their clients, conscientious practice, and the informed consent and shared responsibility with women and families that they encourage in their practices.”

In other words, being friendly with clients is supposed to keep a midwife from being sued for negligence. I already mentioned how I feel about becoming friends with clients; it isn’t a surefire protection against losing a baby or a mother. Having malpractice insurance is not solely so clients can sue the midwife. It is also for times when a baby or mother have been damaged and need on-going care such as an NICU stay or a mother’s vaginal reconstructive surgery. Having liability insurance, to me, is the mark of a professional who takes her job and responsibility very seriously.

In my own state of California, I was led to believe no one offered malpractice insurance to Licensed &/or Certified Professional Midwives. Even the California Association of Midwives website makes no mention of liability insurance availability. If it weren’t for active consumers around the Internet dissatisfied with their homebirth midwifery care, I would still not know several companies offer insurance to homebirth midwives. Contemporary Insurance Services, Inc.is but one organization that sells insurance to midwives. While California’s midwifery law does not require malpractice insurance, it does require us to disclose whether we have it or not. I am currently not attending (as a midwife) homebirths, but I believe if I was, I would find getting insurance an important part of the professionalism of my practice.

I was asked a couple of days ago if I am anti-homebirth now, that this series sounds snarky and like I am really telling women that homebirth isn’t safe at all anymore. Really, really, if I didn’t think there were any homebirth midwives that were qualified to attend to women, I would totally say so. What I’m saying here is what I believe will help women find the right provider for themselves as well as finding one that can keep the woman and her baby safe.

When I talk about the midwife keeping the mom and baby safe and alive, I am not just speaking about during the labor, birth and postpartum time exclusively, but also during the pregnancy. It takes a great deal of skill and experience to catch the nuances of a pregnancy stepping out of the bounds of normal, too. Knowing when to intervene and/or refer to a doctor is a crucial skill. I’m writing this series for those that want a homebirth and who think they might want one… giving the insider information that can help aid a woman’s/family’s search.

As I’ve said before, there are trade-offs when choosing either home or hospital births. Each one has their complication factors, either created or surprise. Each woman has the responsibility (and right!) to weigh the risks and to decide for herself within which risks she is willing to work –and live with for the rest of her life. Many aspects of our lives are risky and we weigh them with the potential benefits every single day. This home vs. hospital choice is no different.

This question is really broad and should not be answered with a rehearsed statement. It was one of the most ambiguous questions I was ever asked and wondered if I answered it right each time because the answer can be so expansive. And someone’s philosophy can be incredibly different than what actually goes down at the birth.

Instead of “What is your philosophy?” asking “What does normal birth look like to you?” can give you much more information.

Asking what normal birth looks like to the midwife can let you know where her parameters are. Does she say a breech or twin birth is a “variation of normal”? This lets you know she’s on the liberal side of midwives, more amenable to delivering breeches and twins at home. If she is on this side of the spectrum, you might ask these next questions.

“What is your experience seeing breeches and twins born?”

“Have you ever assisted with them? Tell me about the experiences.”

“Have you ever been the primary with them? How many and what were the outcomes?”

“How did you learn your breech and twin skills?”

“If we agree to birth either one at home, who else would you have at the birth?”

“Does she also have hands-on skills? Where did she learn her skills.”

Through these questions, you’ll be able to see her exact experience with breeches and twin homebirths, as well as getting to know a part of where she stands on “What’s a complication to you?”

Later, I’ll talk about neonatal resuscitation and hemorrhage which are vital to be explored with both breech and twin births.

If there is no experience and she lets you know twins and breeches are out of her scope of practice, move to these questions that refer to the pregnancy and transfers, more than the actual birth.

“What is the upper limit of a high blood pressure you would feel comfortable with at home? If my blood pressure started going up, what is the process towards eventual transfer?”

“What do you consider a fever in labor and when do you transfer for one?”

Remember to know the answer you're looking for. If you are looking for a conservative midwife, it's important to know the standard of care is to transfer a woman if her blood pressure is 130/90 or 30/15 above her normal blood pressures. (If your blood pressure is usually 90/56, by the time your BP is 130/90, you could be having a stroke!) If you're looking for a more liberal midwife, one who doesn't stick to the rules of what most (medical folks) would consider safe, then knowing her answers will help you here as well. How she answers gives you pieces of the total picture of the type of midwife she is and a decent guideline-roadmap for a normal and inching-out-of-normal pregnancy and birth.

I’m not terribly fond of this line of questioning because the way it’s worded, it presumes the midwife believes preeclampsia is nutrition-based, which, it has been scientifically proven, not to be. I guess if you want to know if she’s still of the belief that the Brewer Diet can help a woman avoid or if she has preeclampsia already, the Diet can relieve the condition, that would be good to know, demonstrating she is not an evidenced-based midwife(some of the links have been locked for privacy), despite her possibly saying she is.

I encourage you to spend as much -or little- time while in the midwifery consult as you need. If after ten minutes, you realize she isn't the one for you, do you both a favor and end the interview as soon as possible. You can always just say, "Thanks for your time, but I can tell we're not a good fit" and be on your merry way. I used to limit the time with interviews, frustrated at hearing the same questions over and over again, ones that were so unimportant in a homebirth interview:

Do you let the cord stop pulsating before you cut it?

Will you let me move around in labor?

Can I push in any position I want to?

Can I keep the baby with me all the time?

As if we were in the hospital. I felt bad that women expended worry and planning time on such basic questions that all have "OF COURSE!" answers. I most certainly answered the questions and also suggested reading materials so they'd get a better idea of what homebirth looks like, but wished I didn't have to go through them at all.

But now, I would take the questions and answer them with more inner patience, using the time to expose the type of midwife I am... one that sees/hears the same thing a thousand times and acts as if it is always the first time. I would not limit the appointments at all. I would not sigh if someone came in with a several page list of questions. I would not say, "We all pretty much have the same training, so pick the midwife you wouldn't mind spending 20 hours with in a small room" because it's not true. Choosing a midwife is not just about personality meshes. It definitely has elements of that, but it is not crucial to become friends with your midwife. In fact, I've found (through my own many mistakes) that not being friends keeps the boundaries clear and allows for decisions to be made autonomously by both provider and client. Each woman has the right and responsibility to keep mom and baby safe and having the space to give the sometimes difficult news of needing to transfer or transport can help the relationship stay in that professional -and trusting- place. There are no pity decisions being made, keeping a mom home because the midwife feels sorry for her, thereby risking the health and possibly life of the two clients. As I said, I learned this the hard way. More than once. If I were to begin my midwifery career again, it would include never (or only on the rare occasion) becoming friends with clients.

Next: More Suggested Questions from Various Websites & Why Not to Ask Them

It’s true, a lot of my questions and thoughts are geared towards the actual birth and the ultimate safety of mom and baby during that time, but the truth is the midwife who takes that part of her job serious enough has surely also found it important enough to know the parameters of safety during the pregnancy as well. Not always so, but in my experience, prepared is prepared is prepared. And, in birth, it always pays to be prepared.

Moving on to when you meet the midwife face to face, please don’t take her office or style of dress as a clue into the type of midwife she is. Or her lovely website. You can get information about her practice from the Internet, though. From The Birth Survey to online forums, listen to the comments and reviews, but tailor their answers to what it is you are looking for. Extremely liberal midwives (in the safety sense, not the political sense) will be heralded on extremely crunchy sites and it might be harder to find information about midwives who are more middle-of-the-road or law-standard-compliant. Websites are just now coming into being that discuss the “radical” midwives and the “hands-off” care they offer/hands-on, life-saving care they didn’t offer, but they are few and far between. So, if your goal is the more experienced, perhaps even safer midwife, you might take a look at the midwife the crunchier sites tell you not to go to. If you want to throw out a question without getting flamed, but are looking for a midwife who operates within the recognized standards of care, you can say, “I’m having twins/breech/VBAmC and want a homebirth, but can’t find anyone. Anyone know who is out there for me?” And whomever they tell you to go to, stay away from! Who they tell you won’t do twins/breeches/VBAmC is most likely the midwife who tries to work within tight parameters of safety. Unless, of course, she has a great deal of experience with those different types of births, but that’s different and discussed above.

One of the most important things you can do is prepare for the meeting. Find out what the laws are regarding homebirth midwives. Is midwifery legal in your state? If so, what are the legal Standards of Care? If midwifery is not legal, try and find out the community’s Standards, often discovered after several different midwife interviews. If you’re in a place with only one or two midwives and you are truly concerned about the safety of yourself and your baby… you are deciding between home and hospital based on the interviews, it’s vital to figure out what the community standards are, even if they are only based on one or two midwives.

Some typical questions about Standards of Care:

“Does this community support having twins or breeches at home?”

“Does the midwifery community believe in ultrasounds if a pregnant woman delivers after 40 weeks?”

“Do the midwives locally give IV antibiotics for GBS positive moms?”

Just those three questions alone can give you a feel for how the midwives in that area practice. Depending on the answers you are looking for will help you know if the community has the same mindset as you. If you wanted to spin the questions a little crunchier, you could ask:

“If there is a problem… like a UTI in pregnancy or bleeding after the birth… and I want to use homeopathy or herbs instead of medications, will your community support you in this? Or will they have a problem with my not using antibiotics or Pitocin.”

“If I went over 42 weeks and still wanted a homebirth, is this something normal in your midwifery community? Or is that frowned upon.”

“What are your views on alternative methods of GBS treatment?”

When you know what style of midwife you’re looking for, knowing the standards of care in the community will let you know if the woman you end up choosing will be seen as a possible renegade or that her actions will be similar to the other midwives you might choose from. This information alone will help hone your choice of midwives.

Over the years, I’ve read and heard a slew of interview questions for doulas and midwives. Some are almost unanswerable and others, terribly irrelevant. Over the next few posts, I’ll take some of the different questions various sites say to ask and I’ll talk about how to change the questions to something relevant and will give the searching woman enough information for her to make a decision about the midwife for her… hands-off… hands-on… or someone inbetween.

But, whomever you’re hiring, it is someone to, ultimately, save the life of you or your baby if a tragic emergency occurs. When a complication occurs in the hospital, there is a team of folks to do the various parts of the job in keeping someone alive. If there are mistakes being made, there is almost always another person there to see it and fix the mistake. In a homebirth setting, you have one, usually two and sometimes three people to save the life/lives. If each person isn’t meticulous in their abilities, there is no back-up team to take over or even witness the mistake/s. This is why choosing the right homebirth midwife is so important.

It is vital for women and their families to understand that while having a baby at home can mean avoiding some too-common emergencies that happen in the hospital (fetal distress from Pitocin or a cord prolapse from rupturing the amniotic sac artificially, for two examples), there are also emergencies that happen in the home that would be able to be handled better and safer if mom and/or baby were in the hospital. If a massive hemorrhage occurs, there are no blood products in the home, nor are there the plethora of means to control bleeding like they have in the hospital. Also, if a baby needs more than minimal resuscitation, the hospital is the place to be for their teams of personnel trained to attend to such emergencies. If parents are able to face these realities and accept the consequences (and I do mean that going both ways: hospital and home), then moving forward to finding the right provider can happen.

When a woman is birthing at home and interviewing a possible provider, it’s important for her to know the answers she’s looking for. For example, if you’re asking about postpartum hemorrhage and “testing” whether the midwife knows her stuff or not, you need to know your stuff in order to gauge the midwife properly. This is one aspect of care that doesn’t happen with OB or CNM care. You know they know how to attend to postpartum hemorrhage, not only because they work with it all too often, but also because their education was standardized and that all of them have the same base of knowledge. In addition, OBs and CNMs regularly attend drills, even if they handled a hemorrhage a day, at least once every 1-4 weeks, they practice with each other so the skills are body memories and each movement is acutely accurate. More on drills later.

This client-as-expert can be one of the most exhausting parts of looking for a homebirth midwife. In the discussion of whether midwifery should be regulated or not, the belief that a client needs to interview the midwife to make sure she’s qualified to attend to her birth is often stated as a reason to not require licensing, that it is ultimately the woman’s responsibility to hire the right midwife, the one that knows her skills well enough to save a life. But, how is the client supposed to learn how to be a midwife and be able to gauge whether the interviewees are wise enough to fulfill their promises during their pregnancy – all the while getting care from these midwives? It’s absurd to expect a woman hiring a midwife to know more than the midwife herself. This is where a standardized education and skills system being in place can not only save the pregnant woman time and energy, but perhaps also her life or that of her baby.

But, for now, the woman does need to almost become a midwife herself before she can interview the midwife accurately. After reading the same midwifery books the midwifery students read, where does the mom begin?

I had a doula-friend ask me a question about one of the babies she saw born a few weeks ago, a baby that she can’t stop thinking about, so she finally decided to ask me what she should have done and if there’s anything she should do now.

The baby was born, had some stress during the birth (meconium, needing a little bit of resuscitation), but did okay afterwards. The baby looked sort of odd to the doula and one of the nurses confided in her she thought so, too. There were a couple of reasons the baby could stay in the NICU for a couple of days, so he did and some tests were run. Infection? Nope. Omething physical? Nothing they could find. He’s home now with his parents, nursing is going so-so, but how unusual is that, right?

The doula wanted to know if she should tell the mom that something is bothering her, that she still thinks something’s going on with the kid. This is my answer.

Sometimes it can be hard to decide what to say and not say. And saying it as a doula is totally different than as a midwife who was hired to care for the mom and baby. Since the hospital’s seen the kid and he’s doing well so far, this is the place of watchful waiting. Or, a better attitude perhaps, one of release.

Because I know you’re considering midwifery, I’ll speak to that, too. It’s great you’re worrying about the baby, wondering if you should tell the mom your thoughts and concerns. But, I encourage you to stay in the “What would I do if I were the care provider?” place instead of becoming the care provider. I know it can be frustrating as all get out when the hospital and pediatrician sends a baby home without answering the initial (and subsequent) question/s, but we have to believe they’ve looked at the most obvious causes and ruled them out. Could they have missed something? Of course. Might something come up they should have found earlier? Of course. But, NICUs are pretty thorough. Too thorough for many of the babies we’ve seen in there, right?

I’ve had a couple of babies I’ve referred to Children’s with distinct problems who left with exactly the same problems, but no cause for it being found. I still remember gasping when they told me the newborn with the heart rate of 70 was going home fine and dandy. What do I say to those parents who got so scared when I was responsible for their child’s hospitalization? Those bills? When the hospital insinuates, “You really didn’t need to come in for that.”? My pat answer is: I’d much rather they say, “You didn’t need to come in” than “Why the hell didn’t you come in?” (“Hell” wasn’t what I wanted to say.) And it is that belief that certainly made my transport rate higher than some/many other midwives, but erring on the side of caution was important to me.

For now, however, as the doula, you don’t have to worry about those things. Embrace this time! Taking that responsibility can be very tough. Right now, as a doula, you can be there as a doula, loving and supporting the mom where she is and how she needs you to help her right now. Even if that means nothing more than supporting her desire or need to do nothing.

If you’re in the child’s life for any length of time, you will learn if there is something wrong or, better yet, see that nothing is wrong at all. If there is something wrong with the baby, the mom will eventually see it and take the kid in. But, perhaps there’s nothing more wrong than the baby not being fully “in his body” yet and he just needs to climb in and things will be better. Know, though, that some kids are just FLKs – Funny-Looking Kids. (Yes, this is a term many midwives use.) Nothing at all wrong with them that we can see or test for, just a quirk of biology.

But, what do we do with those feelings that something isn’t quite right? Why do we have them in the first place. I’ve written before about premonitions versus fear (Premonitions, from June 8, 2006.) and how we can only say it was premonition in retrospect. Intuition is much the same; we can only have the intuition validated after the fact. What do we do with it? As I said above, as the doula, you get to sit on it and let mom and baby unfold their own story.

Knowing nothing about this baby other than what you’ve shared with me, and I have zero premonition about what’s going to happen, but I wanted to mention something that was taught to me early in my midwifery training.

At the birth center where I was, a baby was born that was obviously very deformed and probably not long for the world if the outer body was any indication of the inner workings. We all saw the problems immediately, but the mom was in total bliss about her new baby! She was all over her, kissing her, cooing, touching her all over… loving on her, obviously oblivious to the baby’s probable incompatibilities with life. I was in a position to pull someone out of the room and ask why the heck no one was telling mom they needed to take the baby to the hospital? Why were they letting her be in ignorance instead of telling her there was something seriously wrong with her baby?

I was told that sometimes, the best thing a midwife can do is leave moms in their place of ignorant bliss so they can bond with their babies deeply and without prejudice (i.e. seeing their kid very sick or even gone already). That this “pure” bonding time will only last until someone bursts the bubble with “Your baby is quite ill,” and that time is so very precious and should be preserved and protected as long as possible. I’ve never forgotten that lesson.

But what of those feelings you have that something isn't quite right? Maybe they are about something on a deeper, more spiritual level. Perhaps he's going to be schizophrenic, but that won't appear until he's 22 years old. Perhaps he's going to be profoundly autistic. Perhaps he has a cancer cell already that's going to take him when he's 6. And maybe there's nothing you will ever know about this child, but that, on some level, you are aware of. I really have learned to just let some things lie and let them unfold in their own time. Patience is the hallmark of a midwife, now isn’t it. We never know all the answers. And that can be very frustrating, but can also be extremely freeing if we let it be.

One last thing. As you play the What Would I Do game, be careful not to get too wrapped up in someone else not doing what you would do. That’s another part of the letting go of the situation. Everyone, ourselves included, are allowed to make our own choices… and mistakes. As a parent, you know this lesson very well. It is the same with clients; letting go and watching them make different choices teaches us our own lessons… on many, many levels.

I was asked to remove the blog owner's name, she thinking her blog was private. Therefore, you will not be able to read the post I'm referring to. However, I'm leaving what I have because it's a great discussion even without the entire piece. She wrote “Ummm… not so much” about an article she read about a homebirth, how the article reaffirmed her decision to birth in the hospital.

“One of her (the woman in the article she read) reasons was hey its the way people did it back in the day it must be the right way to do it. Well people also used the bathroom outside and took baths in the creek but we don't those things anymore right? What is so bad about having the baby in the hospital? I had a wonderful dr and labor and delivery nurse and I knew if there was a problem, I was in the right place. There was also the issue of her child being home for the birth. This lady was sitting on the toilet screaming having a baby while her child is coming in and out trying to figure out what is going on. At least take the child to a babysitter!”

It’s so interesting reading others’ take on what many of us find pretty typical, if not downright normal. When moms or family members worry what the kids will think, I remind them that kids usually do better than grandparents… they don’t have the preconceived brainwashing they do. You know, no decades of watching fake-births in movies and on tv; to them, it’s not that big of a deal.

Regarding the peeing in the woods analogy, I always find that so gross. Birth isn’t an elimination function… it’s the bringing forth of a life. And sure, there are advancements we can and should embrace, even in birth. For goodness’ sake, it’s a rare woman who wouldn’t accept medications for hemorrhage or blood products. And I can’t imagine any woman not wanting anesthesia for a cesarean, but when we mechanize the simplicity that is the majority of birth, that’s where the complaints come in.

The analogy of hospitalizing a woman, putting monitors on and in her, people wandering in and out, measuring blood pressure and pulse… and penis size? while having sex with one’s mate… that’s what normal birth foisted into the hospital setting is like. An absurd picture, isn’t it?

The blogger goes on:

“Midwives can't give pain meds and u have to footprint ur child on ur own, they don't do it. They never mentioned going to get the baby checked out by a pediatrician; she just said they cut the cord and then she ate breakfast at the table with her expanded family and then they sat outside watching the other child play. What?? What about all those tests they give when the baby is born? What about height and weight? This article was a little disturbing to me. I understand this may be more comfortable for the mom but what about the safety of the baby? What if something went wrong?”

Actually, dear blogger, if a woman wants pain medication in labor, she does need to be in the hospital because they are so patently unsafe she and the baby must be monitored. Even something as simple (simple?) as a sedative needs constant attention. Nothing given for pain is benign. Nothing.

Most midwives do footprint, but it’s a memorabilia sort of thing since there is no chance your baby will be mixed up with another baby… something that can (and has) happen in the hospital.

We do all the routine tests and administer the state required treatments -if the parents consent to them. Many (most?) of us also do the Newborn Screen which is done about day three postpartum.

Most midwives do recommend the baby be seen by a care provider, usually a pediatrician, within the first few days after a birth. We are able to keep a mom and baby safe through the passage of birth, but we are not specialists in complications of either. If there are any signs of a problem, they are referred (if not transported immediately) to a specialist (obstetrician/pediatrician).

However, we do postpartum visits, checking mom and baby several times after the birth. My own rhythm is 24 and 72 hours, then two and six weeks postpartum. This is more observation than hospital birthing women get; once they are released from the hospital (24 hours or so postpartum), they are not seen again for six weeks.

It seems the mom in the original article (that she does not name) was demonstrating the simplicity that is homebirth… that it was as easy as cutting the cord and then sitting down to eat her breakfast. But, I promise you, the midwife was doing much more than just scrambling eggs and buttering toast.

We do examine the baby, head to toe and side to side. We weigh the baby (see the scale picture below) and measure him/her. How can anyone not want to know those basic facts? Besides, the weight is necessary for the birth certificate, which, in my state, I get to complete and file for the family, too.

We watch the baby during the postpartum period, usually two to three hours, which is what happens in the hospital, too. We make sure mom is nursing well, that her bleeding is under control, that the baby’s breathing well and adjusting to the outside world nicely. We’re taking her blood pressure, both their temperatures, helping mom to the bathroom, helping her to shower, cleaning the room/bed, making the house so that you cannot even tell a birth occurred there. We start the laundry and make sure someone will be with her at all times for the next day or so.

And if something goes wrong, we immediately attend to it and/or move into the hospital setting where, we absolutely acknowledge, they are the specialists in complications. We do carry medications to stop bleeding/hemorrhages, but if it continues and needs more help, we don’t hesitate to get the mom to the hospital. Why would we wait? As midwives, our most outstanding job is to keep the mom and baby alive. No “experience” is worth dying for.

And having a homebirth is not just about “the experience” or to brag about natural birth. For most of us, it is to eliminate the massive amounts of technology shoved onto (and into!) women during birth. While the judicious use of technology is a great thing, the indiscriminate use is what’s abhorrent. When birth is going along swimmingly normal and the wonders of science are required (or highly encouraged) hospital policy, each intervention (continuous fetal monitoring, IV, remaining in bed, no food or drink, pain medications, etc.) carries with it enormous risks. In remaining at home, those risks are avoided and birth can continue unhindered by the commands of impersonal, faceless bureaucrats.

So while you may still scrunch up your face at not ever wanting a homebirth… and you have that right, of course… I felt it was important to clear up a few misconceptions mentioned in your blog post. (I wanted to leave a comment, but the settings are not set to Name/URL, so couldn’t; decided to write here instead!)